Pinworms make their unpleasant rounds across Sisters

Last updated 4/9/2019 at Noon

The common intestinal parasite known as pinworm or threadworm is affecting some Sisters residents. A pharmacist at Bi-Mart said Friday that the store’s inventory of pinworm medicine had sold out.

Symptoms include itching of the anal or vaginal area; insomnia, irritability, and restlessness; and intermittent abdominal pain and nausea, according to the Mayo Clinic. Some infected people have no symptoms at all.

The culprit is a white or yellowish roundworm called Enterobius vermicularis that’s about as long as a staple. Pinworms dwell in the colon and rectum of humans, infecting 20 percent or more of the population. They are most common among children and people who live in institutions — along with their caregivers and household members.

While the infected person sleeps, female pinworms leave the intestine through the anus and lay eggs on the surrounding skin, causing itching and discomfort.

While pinworms are not generally considered a serious health problem, there is a slight risk of more harmful infection such as vaginitis or endometritis, according to the Mayo Clinic.

Local nurse Beth Hummel, R.N., said she would worry about pinworms “getting up into the fallopian tubes, because of the damage they can do, and how uncomfortable for that little girl — or a grown girl, anyone with the plumbing.”

In rare cases, pinworms may also cause urinary tract infection (UTI).

The eggs live up to three weeks outside the body — on skin, bedding, toilets, and toys. People usually become infected via the “oral-fecal route,” where the sticky eggs are transferred via skin or fingernails to food, linens, or other surfaces.

Unknown to many medical practitioners, the Centers for Disease Control and Prevention and Mayo Clinic now report that pinworm eggs can become airborne. Inhalation may cause infection.

“I would love to see how often that actually happens,” said Andy Mohler, a pharmacist at BiMart.

“Don’t shake your sheets out,” said Hummel. “Oh, mercy.”

Emily Livengood, N.D., of Baker Family Naturopathic advised that patients receive a definitive positive diagnosis of pinworm before attempting treatment.

Diagnosis involves obtaining samples from the rectal area. A doctor may diagnose them by sight. Patients may have to collect a sample themselves using a strip of tape and send to a laboratory.

Albendazole or Mebendazole were formerly the go-to prescription drugs for treating pinworms. Some doctors still prescribe them, not realizing that the drugs have skyrocketed in cost.

A recent prescription cost $800 at a Central Oregon pharmacy.

The corporations Amedra Pharmaceuticals and its acquirer Impax Laboratories created a monopoly on prescription pinworm medication in the U.S., according to Consumer Reports. They launched a $400 chewable pill and took the inexpensive version off the market.

There is an over-the-counter alternative. Reese’s Pinworm Medicine (Pyrantel Pamoate Suspension) costs $20-25.

Andy Mohler, a pharmacist at Bi-Mart in Sisters, said it is now back in stock.

“It seems to cycle,” Mohler said of pinworm medicine purchases at the store. “We get a rush for a while, then it disappears. We get some on the shelf and they sit for a very long time. Then there’s a rush, then it disappears again.”

Mohler said he didn’t know if “everyone overreacts” to sudden outbreaks, “or if they’re actually being tested and showing positive. It can become a panic situation with families.”

Killing the worms themselves is a small part of treating pinworm. The tenacious eggs, viable for three weeks, are unwittingly spread around by humans.

Avoiding reinfection takes weeks of intensive cleaning and preventive measures (see sidebar, “Preventing Pinworm Infection,” page 17). Many patients follow up with a second dose two weeks later, followed by three more weeks of intensive cleaning and hygiene.

Preventing Pinworm Infection

While science is beginning to realize that not all parasites are bad, most folks would rather not live with a pinworm infection. Yet some estimates hold that a whopping 20-40 percent of the population carries them — some without realizing it.

“This is a very common infection,” Beth Hummel, R.N., told The Nugget. “I’m positive I’m going to see more cases.”

Pinworms do not observe class differences. They occur in clean households and cluttered ones, in the homes and schools of the rich and poor.

“It’s everybody,” Hummel said. “There is no class, if you will, that’s more prone to it. Elementary schools and daycares are the most common places you see them in kids.”

She noted a common misunderstanding: “People think they get pinworms with their dogs or cats. Humans are the only reservoir for pinworms.”

Hummel’s number-one recommendation for avoiding infection is hand hygiene.

“It’s important to understand that hand sanitizer is not effective,” she said. “It has to be soap and hot water.”

Hands should be washed after using the bathroom, before eating, and before preparing food, and after “accidentally scratching the anal area,” at a minimum. She recommends using the hottest water you can.

Eggs are often spread by getting under the fingernails. “Use a nail brush,” she advised those who suspect they might be exposed. “Keeping the fingernails short would help, too.” Avoid nail-biting.

“Little kids are just terrible about hand-washing and putting their hands in their pants,” observed Hummel, who works with schoolchildren. “Kids usually have longer nails, and if it itches they’re going to scratch it. They don’t really care that people are watching them.”

Those who are infected should see a doctor, then take medicine as prescribed or advised. Then shower first thing every morning.

“If you’ve been resting at night, that’s when the pinworms start to come out—in the morning,” she explained.

Hummel specified showers over baths: “Bathing can just spread them.”

Changing clothes every morning helps, according to Hummel. She also recommends washing clothing, towels, and underclothes every day in the hottest water.

“Hot water is the key.”

After pinworm treatment, many sources recommend re-washing all household linens and clothing in hot water and aggressively disinfecting all surfaces and objects for at least three weeks.

Bleach, strong vinegar, oxygen bleach, thymol (from thyme oil), and Lysol are considered true disinfectants—regular “multi-surface cleaners” or deodorizers won’t get the job done.

Disinfectant should be left on the suspected surface or object according to instructions. Wiping it off is not recommended. Some disinfectants may cause respiratory and other health problems; proceed with caution.

The process may be repeated after a second dose of medication if recommended by the patient’s doctor, usually at the two-week mark.

Homegrown remedies like garlic and pumpkin seeds have not been proved effective. However, natural measures such as attending to hygiene and “gut health” can help prevent a pinworm exposure from turning into a full infection.

A short Australian YouTube video showing the pinworm’s life cycle may be interesting to adults, and help convince children to wash their hands thoroughly. It can be found at tinyurl.com/nugget-pinworms.